Wiki LMSW Supervising....billing issue

[blocke]

MI here, I have a Group practice I bill for. Our local BCBS says that a limited License Social worker can not be credentialed with them. However the new LLMSW doesnt care what I say and tries to find away around what I say. So he called there provider rep and the provider rep said "of course you can bill". I called the rep also as well I can use the LLMSW under the group as he is not credentialed. This provider rep says Sure you can just put the the supervisor as the rendering and and group as billing and put a modifier on it.... Umm, thats fraud, right? I am not sure if I am over thinking this and since it say AJ than it really is ok? Or is there a different CPT for supervision other than the normal 9083/4/7 and I didnt see it? I would still need his name on the claim form somewhere, right? Here is what the provider rep sent as proof. Please help.

Outpatient psychiatric care - facility​

Services are billed on a professional claim - CMS-1500 - instead of the UB-04 claim.​ No more than one service billed on the same day under the same procedure code is payable.​ On the CMS-1500 claim, in field 24D - PROCEDURES, SERVICES OR SUPPLIES, enter the appropriate modifier to identify the type of therapist who provided the service: AH: Fully licensed psychologist​ AJ: Licensed master's social worker, clinical social worker, or limited license master's social worker​ HO: Master's level clinician (includes clinical nurse specialist-certified, certified nurse practitioner, clinical nurse specialist, licensed professional counselor, limited licensed psychologist, licensed marriage and family therapist, limited license professional counselor, limited licensed marriage therapist or temporary limited license psychologist)​ Note: For board-certified or board-eligible psychiatrist, leave blank.​ On the CMS-1500 claim, in field 24J - RENDERING PROVIDER ID, leave both the shaded and unshaded area blank.​

Remember to record the start and end times for psychotherapy sessions.​

For Telemedicine visits, continue to bill the behavioral health procedure codes currently approved for OPC providers and append the appropriate modifiers.​

For telephone (audio) and visual visits, OPC providers should include modifiers on the claim in the following order: 1. The modifier to indicate the licensure level (level of care) for the rendering provider (such as: AH, AJ, HO)​ 2. The telemedicine modifier (either GT or 95)​ 3. The place of service code 02​

For telephone (audio) only visits, OPC providers should include the rendering provider modifier, as appropriate, and the place of service code 02.​

 

[SharonCollachi]

Tell your local BCBS to put the following in writing:

1. LLMSW cannot credential with them, AND
2. LLMSW can be billed under the group with the supervising provider, who did NOT provide services, as the rendering provider.
3. LLMSW can be billed this way with the following licenses as a supervising provider: _______________ (list them).

Without that, I wouldn't do it.

They're telling you to bill as incident-to, but alot of the credentials in that list are not allowed to have anyone be incident-to with them.

 

[blocke]

Tell your local BCBS to put the following in writing:

1. LLMSW cannot credential with them, AND
2. LLMSW can be billed under the group with the supervising provider, who did NOT provide services, as the rendering provider.
3. LLMSW can be billed this way with the following licenses as a supervising provider: _______________ (list them).

Without that, I wouldn't do it.

They're telling you to bill as incident-to, but alot of the credentials in that list are not allowed to have anyone be incident-to with them.

That is a good idea, thank you. I am so glad I was not reading to much into this. It just felt really not right.